Billing code 45384: Colonoscopy polyp removalMedicare rate & RVUs in Guam
Reports colonoscopic removal of a polyp or other lesion using hot biopsy forceps or bipolar cautery during a flexible colonoscopy.
Medicare pays $583.79 for 45384 in the office in Guam (Hawaii, Guam). Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 9 sections
What 45384 covers
During flexible colonoscopy, the endoscopist removes a polyp or other lesion using hot biopsy forceps or bipolar cautery. Gastroenterologists and colorectal surgeons commonly perform this in an endoscopy center or hospital outpatient department; it may also be performed in an appropriately equipped office. For example, a polyp treated with cautery during the examination is reported by the removal method, not as a diagnostic-only examination.
Select this code when the documented removal technique is hot biopsy forceps or bipolar cautery; a snare removal is reported with a different code. The procedure note should identify the lesion and document the technique used. The diagnostic examination is part of the therapeutic colonoscopy, rather than a separate diagnostic service for that same examination. This minor procedure has a 0-day global period, so same-day preoperative and postoperative care is included. When related endoscopies are performed together, CMS endoscopy family pricing applies. Modifier 50 is inappropriate. Medicare does not pay an assistant at surgery for this service, and co-surgeon and team-surgery billing are not permitted.
This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.
45384 in Hawaii, Guam
| Payment locality | Office | Facility |
|---|---|---|
| Hawaii, Guam | $583.79 | $201.74 |
How the 45384 rate is calculated
Each of 45384’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 45384
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 3.97Practice expense 11.57Malpractice 0.61
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 45384
The CMS indicators that decide how 45384 is paid alongside other services.
CMS payment indicators · 45384
Colonoscopy polyp removal
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 000 | Same-day global: pre- and post-op care on the day of the procedure is included. |
| Multiple procedures | 3 | Endoscopy family rules apply. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 1 | Not paid (statutory restriction). |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
45384 without 51 · national office
$539.42
Colonoscopy polyp removal
45384-51 · Second procedure: 50%
$269.71
When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).
45384 compared with similar codes
Compare codes
45384 vs 45385 vs 45380 vs 45390 vs 45378: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 45385Snare polypectomy
- 45384 is for removal with hot biopsy forceps or bipolar cautery; 45385 is for removal by snare.
- 45380Colonoscopy with biopsy
- 45380 reports colonoscopic biopsy sampling. Choose 45384 when the lesion is removed using hot biopsy forceps or bipolar cautery.
- 45390Colonoscopy
- 45390 is used for endoscopic resection rather than the cautery removal technique represented by 45384.
- 45378Colonoscopy
- 45378 describes a diagnostic colonoscopy without therapeutic lesion removal; when the examination includes removal under 45384, the diagnostic inspection is included.
45384 billing questions
When should 45384 be chosen over 45385?
Use 45384 when the lesion is removed with hot biopsy forceps or bipolar cautery. Use 45385 when the documented removal method is a snare.
Can the diagnostic colonoscopy also be reported?
The diagnostic inspection is included when the colonoscopy proceeds to lesion removal during the same examination. Do not separately report 45378 for that same examination.
How does 45384 differ from a colonoscopy biopsy?
45384 represents lesion removal by cautery technique. Use 45380 when the service is tissue sampling by biopsy rather than removal using the 45384 technique.
What documentation supports reporting 45384?
The procedure note should identify the lesion and state that hot biopsy forceps or bipolar cautery was used to remove it. The documented technique distinguishes this code from snare removal.
Can an assistant surgeon or co-surgeon be reported?
Medicare does not pay an assistant at surgery for this service. Co-surgeon and team-surgery billing are not permitted.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file lines behind this rate
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